Late Recovery of Parathyroid Function After Total Thyroidectomy: A Case-Control Study
Juan José Díez 1 2 , Emma Anda 3 , Julia Sastre 4 , Begoña Pérez Corral 5 , Cristina Álvarez-Escolá 6 , Laura Manjón 7 , Miguel Paja 8 , Marcel Sambo 9 , Piedad Santiago Fernández 10 11 , Concepción Blanco Carrera 12 , Juan Carlos Galofré 13 , Elena Navarro 14 , Carles Zafón 15 , Eva Sanz 15 , Amelia Oleaga 8 , Orosia Bandrés 16 , Sergio Donnay 17 , Ana Megía 18 , María Picallo 9 , Cecilia Sánchez Ragnarsson 7 , Gloria Baena-Nieto 19 , José Carlos Fernández-García 20 21 , Beatriz Lecumberri 6 , Manel Sahún de la Vega 22 , Ana R Romero-Lluch 14 , Pedro Iglesias 1 2
The clinical characteristics of patients with postoperative hypoparathyroidism who recover parathyroid function more than 12 months after surgery have not been studied.
We aimed to evaluate whether the intensity of replacement therapy with calcium and calcitriol is related to the late recovery of parathyroid function. We compared the demographic, surgical, pathological, and analytical features of two groups of patients: cases, i. e., late recovery patients (those who recover parathyroid function>1 year after thyroidectomy, n=40), and controls, i. e., patients with permanent hypoparathyroidism (n=260).
Replacement therapy with calcium and calcitriol was evaluated at discharge of surgery, 3-6 months, 12 months, and last visit. No significant differences were found in clinical, surgical, pathological, or analytical characteristics between cases and controls.
The proportion of cases who required treatment with calcium plus calcitriol at 12 months was significantly lower than that found in controls (p<0.001). Furthermore, daily calcium and calcitriol doses in controls were significantly higher than those in cases at 3-6 months (p=0.014 and p=0.004, respectively) and at 12 months (p<0.001 and p=0.043, respectively). In several models of logistic regression analysis therapy with calcium and calcitriol at 12 months was negatively related to late recovery of parathyroid function.
Although delayed recuperation of parathyroid function after total thyroidectomy is uncommon (13%), follow-up beyond 12 months is necessary in patients with postoperative hypoparathyroidism, especially in those whose needs of treatment with Ca and calcitriol are reducing over time.